Mean Duration Of Motor Block Research Articles

Comparative study of tramadol and nalbuphine as an adjuvant to ropivacaine in supraclavicular block: A cross sectional observational study

Brachial plexus block via supraclavicular approach performed with the help of ultrasound assistance, is a promising anaesthetic alternative for upper limb surgery, when compared with general anaesthesia. It provides good surgical anaesthesia and better post-operative analgesia. We compared the anaesthetic and analgesic efficacy of two additives, nalbuphine and tramadol with 0.375% ropivacaine.A double-blind, cross-sectional study, performed prospectively on 82 patients who were randomly assigned into Group N (41) and Group T (41). Patients were posted for surgical procedure of upper limb under supraclavicular brachial plexus block. Group N received inj. Ropivacaine 0.375% 25 ml plus 1ml (10 mg) of Nalbuphine plus 1ml of normal saline. Patients in Group T received inj. Ropivacaine 0.375% 25 ml with Inj. Tramadol 2 ml (100 mg). Total volume was 27 ml in both groups. Duration of postoperative analgesia was the primary outcome of our study. The secondary outcomes were the sensory and motor block characteristics (onset and duration), change in hemodynamic parameters and side effects.A statistically significant difference was noted in the duration of postoperative analgesia [Group N: 648.27 (± 124.69) minutes, Group T: 514.73 (± 43.15) minutes; P <0.001]. In terms of onset of both sensory and motor block no statistically significant difference was noted. A significant difference was noted in duration of sensory block (Group N: 545.85 ± 118.13 min; Group T: 416.71 ± 50.43 min; P <0.001). The mean duration of motor block was 482.93 ± 120.07 min in nalbuphine group and 356.59 ± 43.74 min in tramadol group; P <0.001.Nalbuphine 10mg is a better adjuvant to 0.375% ropivacaine when compared with tramadol 100 mg. It prolongs the duration of sensory block and motor block and increases the duration of analgesia postoperatively.

Effects Of Low Doses Of Intrathecal Clonidine And Dexmedetomidine With Bupivacaine On The Duration Of Sensory And Motor Block In Abdominal And Lower Limb Surgeries- A Prospective Randomised Double Blinded Study

BACKGROUND: The purpose of this study is to compare the duration of sensory and motor block in elective lower limb and abdominal procedures following intrathecal administration of bupivacaine along with adjuvants either clonidine or dexmedetomidine. METHODS: A prospective randomised double blinded study. 120 study participants were randomly allocated to three groups-Group A was given 12.5 mg of hyperbaric bupivacaine, Group B was given 3 mcg dexmedetomidine along with 12.5 mg hyperbaric bupivacaine and Group C was given 30 mcg of clonidine along with hyperbaric bupivacaine. The duration of sensory and motor block was recorded. RESULTS: Group B and C study participants showed significantly longer duration of sensory and motor block when compared to Group A. The mean duration of sensory block in Group A was 92.5 minutes, Group B 124.5 minutes Group C (119.4 minutes) (A vs B, A vs C p<0.001). The mean duration of motor block in group A 149.1 min, group B 252.5 min, Group C 217 min (A vs B, A vs C, B vs C P<0.001) CONCLUSION: By adding 3 mcg dexmedetomidine or 30 mcg clonidine to hyperbaric bupivacaine duration of sensory and motor block was significantly prolonged.

Effects of dexmedetomidine, fentanyl and magnesium sulfate added to ropivacaine on sensory and motor blocks in lower abdominal surgery: a randomized clinical trial.

This study aimed to compare the effects of intrathecal dexmedetomidine, fentanyl and magnesium sulfate added to ropivacaine on the onset and duration of sensory and motor blocks in lower abdominal surgery. This double-blind randomized clinical trial included 90 patients scheduled for lower abdominal surgery at Vali-Asr Hospital in Arak, Iran. The enrolled patients were randomly divided into three equal groups and then underwent spinal anesthesia. The first group received 10 μg of dexmedetomidine, the second group received 50 μg of fentanyl, and the third group received 200 mg of 20% magnesium sulfate intrathecally in addition to 15 mg of 0.5% ropivacaine. In the dexmedetomidine group, the mean arterial blood pressure was lower than the other two groups (P = 0.001). Moreover, the time to onset of sensory block (P = 0.001) and the mean duration of sensory block (P = 0.001) were shorter and longer, respectively, in the dexmedetomidine group than in the other two groups. In the dexmedetomidine group, the mean time to onset of motor block (P = 0.001) and the mean duration of motor block (P = 0.001) were lower and higher than in the other two groups, respectively. There was no significant difference in visual analog scale score, heart rate, administered opioid, and drug side effects among the three groups. Dexmedetomidine caused early sensory and motor blocks while prolonging the duration of sensory and motor blocks compared with the other two groups. In addition, dexmedetomidine reduced mean arterial blood pressure in patients. Based on the findings of this study, it is recommended that dexmedetomidine can be used in order to enhance the quality of sensory and motor block in patients.

A COMPARISON OF DEXMEDETOMIDINE AND BUPRENORPHINE AS AN ADJUVANT WITH 0.5% BUPIVACAINE IN PERIPHERAL NERVE STIMULATOR (PNS) GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK - A PROSPECTIVE DOUBLE BLINDED RANDOMIZED CLINICAL STUDY

Background And Aims: We compared the block quality and characteristics between dexmedetomidine versus buprenorphine as an adjuvant to bupivacaine in Peripheral nerve stimulator guided supraclavicular brachial plexus block. The quality of block by dexemetomidine was found to be better than buprenorphine and thus has opioid sparing action. Duration of sensory and motor block along with duration of analgesia were the primary outcomes studied. Methods:Total 80 patients of either sex, 40 patients in each group presenting for upper limb surgeries Each participant fullling our inclusion criteria then included. Results: In our study group D represents the group that received dexemotomidine while group B represents the group that received buprenorphine Mean duration of sensory block in group D was (704.05± 123.16) min and in group B it was (543.25 ± 60.14) min while mean duration of motor block in Group D (& (662.05± 121.83) was longer than Group B (397.50±56.51) and Duration of analgesia in Group D (782.88 ±115.44) was also longer than Group B (636.25±53.62).The results were statistically signicant. Conclusion: Dexmedetomidine I dose of 1ug/kg prolongs the duration of sensory and motor blockade and duration of analgesia as compared with buprenorphine when used as an adjuvant to 0.5%bupivacaine in supraclavicular brachial plexus block, with no major adverse side effects

RANDOMIZED COMPARATIVE STUDY OF ANALGESIC EFFICACY OF BUPRENORPHINE AND CLONIDINE AS ADJUVANTS WITH INTRATHECAL BUPIVACAINE IN PATIENTS UNDERGOING TOTAL ABDOMINAL HYSTERECTOMY.

Introduction: Understanding pain and continued efforts to alleviate pain is utmost priority perioperatively. Most often pain is underestimated in all age groups. This study is intended to evaluate and compare analgesic efcacy of two drug combinations with local anesthetic agent in spinal anesthesia. In this study efcacy of Clonidine-Bupivacaine, Buprenorphine-Bupivacaine and Bupivacaine is studied in patients undergoing total abdominal hysterectomy. This study was a prospective randomized study conducted on 114 patients age Material and Methods: d 35-60 years who underwent total abdominal hysterectomy at Sri Siddhartha Medical College and Research institute for a period of 24 months.After the approval of institutional ethical clearance committee, 114 ASA I and II patients scheduled for elective total abdominal hysterectomy were selected for study. All the patients were evaluated as per the protocol. The anesthetic procedure was explained to the patients in a simple language and informed consent were obtained. The patients were divided into three groups of 38 each using chit in a box technique. Three groups included Bupivacaine 0.5% hyperbaric (Group B), Clonidine and Bupivacaine 0.5% hyperbaric (Group BC), Buprenorphine and Bupivacaine 0.5% hyperbaric (Group BB). Time of onset of sensory blockade, the height of sensory blockade, motor blockade as per Bromage scale were recorded. Total duration of sensory blockade and motor blockade were also noted. Quality of analgesia (visual analogue score), two segment sensory regression time and time to rst rescue analgesia in 24h were documented. Results:The total duration of analgesia was statistically signicant in all three groups. The mean duration of analgesia was 2.436 ± 0.24h in group B, 2.96 ± 0.32h in group BB and 4.35± 0.62h in group BC. The total duration of motor block was found to be statistically signicant between the groups. Mean duration of motor block was 3.10 ± 0.34h in group B , 3.41 ± 0.25h in group BB, 4.48± 0.19h in group BC. The VAS score was found to be statistically signicant between the groups. It was 4.68 ± 0.47 in group B, 4.92 ± 1.07 in group BB and 4.42± 0.50 in group BC. Clonidine is an effective intrathecal Conclusion: adjuvant to Bupivacaine(H) than Buprenorphine in providing post-operative analgesia and the analgesic efcacy of both Clonidine and Buprenorphine as adjuvants with Bupivacaine(H) were better than Bupivacaine(H) alone.

Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine in Ultrasoundguided Supraclavicular Brachial Plexus Block: A Prospective Observational Study

Introduction: Upper limb surgeries are mostly performed under supraclavicular brachial plexus blocks which provide intraoperative and postoperative analgesia. Ultrasound provides clinicians with real-time images which are useful for better identification of the anatomical structures, safe needle placement, and adequate local anaesthetic spread. Adding adjuvants to local anaesthetic drugs prolong the duration of anaesthesia without concomitantly increasing the risk of complication. Aim: To compare fentanyl and dexmedetomidine when added as an adjuvant to ropivacaine for Ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: A prospective observational, doubleblinded study was conducted in the Department of Anaesthesia, at Government Medical College, Kottayam, Kerala, India, on 52 patients undergoing orthopaedic upper limb surgeries over a period of one year from April 2019-March 2020. Patients were divided into two groups of 26 subjects each. Group A received ropivacaine 0.5% (20 mL)+dexmedetomidine 1 mcg/kg and group B received ropivacaine 0.5% (20 mL)+Fentanyl 1 mcg/kg. Onset, time to complete sensory and motor block, duration of sensory and motor block, duration of analgesia, adverse effects and haemodynamic status were monitored. Statistical analysis was done using t-test and Chi-square test. Results: The demographic variables, onset of sensory and motor block were comparable in both the groups. Mean duration of sensory block in group A and B were 638.08±52.001 minutes and 568.85±36.478 minutes respectively. The mean duration of motor block in group A was 605.77±58.8 minutes and group B was 513.46±14.982 minutes. The mean duration of analgesia in group A and B were 722.3±58.13 and 615.00±48.19 minutes, respectively. Mean duration of sensory block, motor block and analgesia were found more in group A which was statistically significant with p-value=<0.05. There was no significant difference in haemodynamic parameters. Conclusion: Dexmedetomidine was a better adjuvant to 0.5% ropivacaine as compared to fentanyl in Ultrasound-guided supraclavicular brachial plexus block in terms of duration of sensory block, motor block and analgesia.

A prospective, randomised, double blind study comparing dexamethasone and dexmedetomidine as adjuvants to 0.2% ropivacaine for post-operative analgesia in ultrasound guided brachial plexus block

The Adjuvants added to local anaesthetic increases the duration of post-operative analgesia and decreases the analgesic requirement in post-operative period. The study was conducted with the intent of comparing post-operative analgesic effect of Dexamethasone and Dexmedetomidine in ultrasound guided Brachial Plexus Block. A prospective, randomised, double blind study to compare post-operative analgesic effect of Dexamethasone and Dexmedetomidine as adjuvant to 0.2% Ropivacaine in Ultrasound Guided Brachial Plexus Block. 60 patients belonging to ASA I and ASA II scheduled for upper limb surgeries were included in the study after taking informed consent. Group A received 20ml of 0.2% Ropivacaine with 8mg of Dexamethasone. Group B received 20ml of 0.2% Ropivacaine with 50 µg of Dexmedetomidine. Our primary objective was to compare the time to first request for analgesia in both the groups. Secondary objective was to compare duration of sensory and motor block in post-operative period and to compare overall requirement for analgesia in 24 hours in both the groups. The mean duration of motor block in Dexamethasone group was 635.47 ± 26.29 minutes and in Dexmedetomidine group was 827.47 ± 54.62 minutes. Similarly, mean duration of sensory block was 681.5 ± 27.19 minutes in Dexamethasone group and 877.17 ± 52.85 minutes in Dexmedetomidine group. The mean duration of time to first rescue analgesic was 709.67+18.47 minutes in dexamethasone group and 910.2 ± 51.66 minutes in Dexmedetomidine group. Total analgesia given had significant statistical difference of 0.004 between the two groups, with mean of 1.23 ± 1.17 in Dexamethasone group and 0.4 ± 0.56 in Dexmedetomidine. However, at 2hr, 4hr, 8hr, 12hr, 18hr and 24 hr the difference in VAS scores was significant (p value <0.0001). Dexmedetomidine is better than Dexamethasone in prolonging duration of analgesia of the Brachial plexus block.

Comparison of Intravenous Dexamethasone and Dexmedetomidine for Spinal Anesthesia Quality in Opium-Addicted Patients: A Parallel Double-Blind Randomized Clinical Trial

Background: Spinal anesthesia (SA) is a frequently used method by anesthesiologists in patients who may not need general anesthesia or have a contraindication for applying general anesthesia. Nevertheless, numerous contemplations need to be considered by anesthesiologists when using this method. Objectives: We compared the effect of intravenous (IV) administration of dexamethasone versus dexmedetomidine alongside the subarachnoid injection of Bupivacaine in terms of spinal anesthesia (SA) quality in opium-addicted patients. Patients and Methods: This parallel randomized clinical trial (RCT) was conducted on opium-addicted patients aged 18 to 65 with The American Society of Anesthesiologists (ASA) class of I/II candidates for surgery under SA. In one group, dexmedetomidine at a dose of 0.5 μg/kg body weight was injected intravenously 10 minutes before surgery and then at a dose of 0.5 μg/kg body weight during surgery. In another group, 8 mg dexamethasone was injected intravenously 10 minutes before surgery, and then normal saline at a rate of 0.5 μg/kg/h was infused during surgery. The primary outcomes were the onset of sensory block, the onset of motor block, the regression of two levels of sensory block, and the duration of motor block. The secondary outcomes were total analgesia time and the time to the first analgesia requirement. Results: Totally, 57 patients divided into two groups were included in the final analysis. The results showed that the two groups differed significantly in none of the assessed baseline variables (P > 0.05). The mean duration between performing SA and the onset of sensory block in the Dexamethasone and Dexmedetomidine groups was 4.8 ± 2.2 and 4.2 ± 1.9 minutes, respectively (P = 0.290). The mean duration between performing SA and the onset of motor block in the dexamethasone and dexmedetomidine groups was 5.9 ± 2.6 and 5.1 ± 2.3 minutes, respectively (P = 0.251). The mean duration between performing SA and the regression of two levels of sensory block in the dexamethasone and dexmedetomidine groups was 63.6 ± 27.7 and 82.0 ± 17.1 minutes, respectively (P = 0.004). The mean duration of motor block in the dexamethasone and dexmedetomidine groups was 75.0 ± 32.1 and 97.5 ± 19.4 minutes, respectively (P = 0.377). The mean total analgesia time in the dexamethasone and dexmedetomidine groups was 86.9 ± 32.9 and 109.3 ± 16.3 minutes, respectively (P = 0.002). The mean duration between performing SA and the first requirement for analgesic agent administration in the dexamethasone and dexmedetomidine groups was 206.21 ± 93.19 and 267.86 ± 76.02 minutes, respectively (P = 0.008). Conclusions: It seems that the quality of spinal anesthesia in opium-addicted patients who received concurrent IV dexmedetomidine was better than that of those who received concurrent IV dexamethasone.

A Comparative Study of Intrathecal Hyperbaric Bupivacaine 0.5% with Morphine and Dexmedetomidine in Lower Limb Orthopedic Surgeries: A Double-Blind Randomized Clinical Trial.

Pain and its alleviation have been a challenge for humans for centuries. Sub arachnoid block is most commonly practiced method for anaesthesia for lower limb surgeries. Adjuvants like opioids and alpha 2 agonists have proven benefits in augmentation of effects of local anaesthetics for spinal anesthesia. The aim of this study was to compare the effects of morphine and dexmedetomidine for sub arachnoid block in lower limb orthopaedic surgeries. This is a prospective randomised controlled trial done in 120 patients who were posted for lower limb orthopaedic surgery. Along with bupivacaine, Group A received intrathecal dexmedetomidine while group B received intrathecal morphine. the demographic profile was comparable in both the groups. The mean duration of motor block in Group A was 359.33 ± 34.4 and in Group B was 265.71 ± 28.47. The duration of rescue analgesia was almost double in Group A as compared to Group B with P < 0.0001 (CL 95%). Intrathecal dexmedetomidine and morphine both provided good postoperative analgesia. Dexmedetomidine provided a longer duration of analgesia than morphine, thereby increasing the time for first rescue analgesia, but at the cost of greater side effects.

Perineural Administration of Dexmedetomidine in Axillary Brachial Plexus Block Provides Safe and Comfortable Sedation: A Randomized Clinical Trial.

Dexmedetomidine prolongs the duration of regional block while its systemic sedative effect when administered perineurally is unknown. We aimed to evaluate the systemic sedative effect of perineural dexmedetomidine in patients after axillary brachial plexus block (ABPB). This single-blinded prospective randomized control trial included 80 patients undergoing wrist surgery receiving ABPB. Patients were randomized into two groups – Control group (CG, N = 40) and dexmedetomidine group (DG, N = 40). Both groups received ABPB with 20 ml of 0.5% Bupivacaine and 10 ml of 2% Lidocaine. Additionally, patients in DG received 100 mcg of dexmedetomidine perineurally. Depth of sedation was evaluated using Narcontrend Index (NI) and Ramsay Sedation Scale (RSS) immediately after ABPB and in several time points up to 120 min. Duration of block as well as patient satisfaction with sedation was evaluated using a postoperative survey. Our results showed that NI and RSS statistically differed between groups, presenting a deeper level of sedation during the first 90 min in DG compared to controls, P < 0.001. In the first 10 to 60 min after ABPB the median RSS was 4 (IQR within median) and median NI was 60 (IQR 44–80) in DG group, in contrast to CG patients where median RSS was 2 (IQR within median) and median NI was 97 (IQR 96–98) throughout surgery. The level of sedation became equal in both groups 90 and 120 min after ABPB when the median NI value was 98 (97–99) in DG and 97.5 (97–98) in CG, P = 0.276, and the median RSS was 2 (IQR within median) in both groups, P = 0.128. No significant intergroup differences in hemodynamic or respiratory parameters were found. Patients in DG expressed satisfaction with sedation and 86.5% noted that the sensation was similar to ordinary sleep. In DG mean duration of motor block was 13.5 ± 2.1 h and sensory block was 12.7 ± 2.8 h which was significantly longer compared to CG 6.3 ± 1.5 h, P < 0.001 and 6.4 ± 1.8 h, P < 0.001. We found that beside prolongation of analgesia, perineural administration of dexmedetomidine might provide rather safe and comfortable sedation with no significant effect on hemodynamic or respiratory stability and yields a high level of patient satisfaction.

Ultrasonography guided supraclavicular brachial plexus block: comparison of sensori-motor blockade and duration of postoperative analgesia between ropivacaine and levo-bupivaine

The study was conducted to compare the onset time, duration and quality of analgesia between 0.5% levo-bupivacaine and 0.5% ropivacaine given in brachial plexus. This prospective, triple blind randomized controlled trial was conducted between January 2020 to December 2021. Seventy patients were randomly allocated into two groups of 35 patients each to receive USG guided brachial plexus block with 30 ml of 0.5% levo-bupivacaine or 30 ml of 0.5%ropivacaine. Blinded observer recorded the onset time and duration of brachial plexus block. Patient characteristics regarding age, weight, and surgical time were comparable in the two groups. The mean onset time of sensory blockade with 0.5% ropivacaine and 0.5%levo-bupivacaine was clinically comparable in our present study. The mean duration of sensory block with 0.5% ropivacaine and 0.5% levo-bupivacaine was also comparable in study. The mean onset time for motor block with 0.5%levo-bupivacaine was lesser than 0.5% ropivacaine. The mean duration of motor block observed in present study with 0.5% ropivacaine was lesser than 0.5% levo-bupivacaine. Mean duration of post operative analgesia of 485.0 ± 76.90 mins (8.08 hrs) was noted with 0.5%ropivacaine and 491.91 ± 92.99 mins (8.2 hrs) with 0.5%levo-bupivacaine which was clinically comparable and the difference was statistically insignificant.

ASSOCIATION DEXMEDETOMIDINE AND DEXAMETHASONE AS AN ADJUVANT TO LEVOBUPIVACAINE FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN PATIENTS UNDERGOING UPPER LIMB SURGERIES.

Introduction: Brachial plexus block has evolved into an excellent substitute to general anaesthesia for upper limb surgeries. By curtailing the 1 stress response and using minimal anaesthetic drugs it provides intraoperative analgesia along with prolonged postoperative pain-relief. Varied avenues of brachial plexus blockade exist namely interscalene, supraclavicular, infraclavicular and axillary approach. With swift onset of dense anaesthesia of upper limb, supraclavicular brachial plexus block (SCBP) block is considered as the 'spinal of the arm. Objective: To conduct a comparative evaluation between Dexmedetomidine and Dexamethasone as an adjuvant to Levobupivacaine for supraclavicular brachial plexus block inpatients undergoing upper limb surgeries. Material and Methods: This is a prospective randomized controlled intervention study was Patients undergoing elective upper limb surgeries under supraclavicular brachial plexus block at orthopaedic surgery rooms of MGM Medical College From March 2019 to August 2020 Patients aged between 20-60 years of either sexes. Patients belonging to ASA Grade I and ASA Grade II and Patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block in included in this study. Result: The mean Onset of sensory block (mean± s.d.) of patients was higher in Group-C [13.2333± 1.6333 Mins] compared to Group-S patients [11.2000± 1.1265(Min)] which was statistically signicant (p&lt;0.0001). the mean Duration of Sensory Block (mean± s.d.) of patients was higher in Group-S [753.5667± 5.2172 (Min)] compared to Group-C patients [718.2333± 25.7504 (Min)] which was statistically signicant (p&lt;0.0001). the mean Duration of Motor Block (mean± s.d.) of patients was higher in Group-S [708.5667± 4.2644 (Min)] compared to Group-C patients [682.3667± 20.0095 (Min)] which was statistically signicant (p&lt;0.0001). Conclusion: The difference of mean Fingers 0 (p=0.6311), Fingers 5 (p=0.8860), Fingers 10 (p=1.0000), Fingers 15 (p=1.0000), Fingers 20 (p=1.0000), Fingers 25 (p=0.5936) and Fingers 30 (p=0.8469) with both Groups were not statistically signicant. Bromage Score 0 (p=0.8469), Bromage Score 5 (p=0.8355), Bromage Score 10 (p=0.5693), Bromage Score 15 (p=0.5671), Bromage Score 20 (p=0.5671), Bromage Score 25 (p=0.6973) and Bromage Score 30 (p=0.7176) with both Groups were not statistically signicant.

Efficacy of Clonidine versus Dexmedetomidine as Adjuvants to 0.5% Ropivacaine in Nerve Stimulator Guided Supraclavicular Brachial Plexus Block- A Randomised Clinical Study

Introduction: Supraclavicular brachial plexus block is used for providing pain relief in upper limb surgeries and has many advantages over general anaesthesia. Alpha-2-adrenergic agonists are chosen with local anaesthetics for their sedative, analgesic and antihypertensive properties. Aim: To compare the efficacy of clonidine and dexmedetomidine when added to 0.5% ropivacaine in nerve stimulator guided supraclavicular block when performed for upper limb surgeries. Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesia Mata Chanan Devi Hospital, New Delhi, India (tertiary care center), from September 2015 to September 2016. Total 90 patients were randomly allocated into three groups. Group A {Inj. ropivacaine 0.5% (29 mL)+ normal saline 1 mL to make 30 mL}, group B {Inj. ropivacaine 0.5% (29 mL)+ clonidine 1 μg kg-1 to make 30 mL) and group C {Inj. ropivacaine 0.5% (29 mL)+ dexmedetomidine 1 μg kg-1 to make 30 mL}. Parameters observed included onset of sensory and motor block, total motor duration, postoperative analgesia as primary outcome; and intraoperative haemodynamic parameters and side effects as secondary outcome. Results: All the three groups were found to be similar with demographic profile. Patients in dexmedetomidine group showed faster onset and longer duration of sensory and motor blocks (p-value&lt;0.01). The mean onset of sensory block in minutes was 12.03±2.20, 8.20±1.40, 6.80±1.35 in groups A, B and C, respectively (p-value&lt;0.001). The mean onset of motor block in minutes was 18.47±2.78, 13.37±2.86 and 11.30±2.04 in group A, group B and C, respectively (p-value&lt;0.001). The mean duration of analgesia in group A, B and C was 555.17±65.36, 710.00±73.58 and 902.67±116.65 minutes, respectively (p-value&lt;0.001). The mean duration of motor block in group A, group B and group C were 330.00±51.78, 418.17±38.29 and 516.83±50.33 minutes, respectively (p&lt;0.0001). The duration of postoperative analgesia and total motor duration were significantly prolonged in dexmedetomidine group than group A and B. Conclusion: It can be concluded that both clonidine and dexmedetomidine increases the total motor duration and postoperative analgesia when added to ropivacaine, but dexmedetomidine is a better choice when used in supraclavicular block, without any significant side-effects.

A COMPARISON BETWEEN INTRATHECAL NALBUPHINE VERSUS FENTANYL AS AN ADJUVANT WITH 0.5% HYPERBARIC BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LOWER SEGMENT CESAREAN SECTION

Background: Subarachnoid block is the preferred anesthesia for cesarean section, being simple to perform and economical with rapid onset. This study aims to compare the postoperative analgesia of intrathecal nalbuphine and fentanyl as adjuvants to bupivacaine in cesarean section.&#x0D; Methods: A prospective, randomized, double?blind, and comparative study was conducted on 120 patients of American Society of Anesthesiologists (ASA) physical status I and II. These patients were randomized into three groups with fifty patients in each group. Group A received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml nalbuphine (0.8 mg), Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 ?g), and Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline.&#x0D; Results: The mean duration of sensory block was 107.32 ± 5.36 min in Group A, 111.23 ± 4.23 min in Group B, and 85.69 ± 2.31 min in Group C. The mean duration of motor block (time required for motor block to return to Bromage’s Grade 1 from the time of onset of motor block) was 152.02 ± 3.12 min in Group A, 151.69± 2.36 min in Group B, and 122.12 ± 2.32 min in Group C.&#x0D; Conclusion: We concluded that intrathecal nalbuphine prolongs postoperative analgesia maximally and may be used as an alternative to intrathecal fentanyl in cesarean section.&#x0D; Keywords: Nalbuphine, Bupivacaine, Fentanyl.

Effectiveness of Nalbuphine with Ropivacaine in Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries

Objective: To investigate the effectiveness of ropivacaine in supraclavicular brachial plexus block by nalbuphine and compare it to ropivacaine alone. Study Design: Randomized controlled trial Place and Duration of Study: Department of Anaesthesia, Fatima Memorial Hospital/College of Medicine &amp; Dentistry, Lahore from 1st June 2020 to 31st March 2021. Methods: Ninety six patients of both genders with ages 20 to 65 years undergoing upper limb surgical procedure electively were included. All the patients were divided equally in to two groups, each group consist of 48 patients. Group A treated with ropivacaine with nalbuphine and group B treated with ropivacaine normal saline. Effectiveness between both groups was examined. Results: No significant difference was observed regarding age, gender, body mass index and ASA class I/II between both groups with p-value &gt;0.05.A significant difference was found regarding onset time of sensory and motor block between both groups (p=0.001). Mean sensory block duration in group A was more 425.18±17.82 minutes as compared to group B 254.43±20.44 minutes. Mean duration of motor block was also more in group A 418.65±20.84 minutes as compared to group B 226.15±12.52 minutes. Duration of analgesia was high in group A as compared to group B with p-value &lt;0.05. Conclusion: In supraclavicular brachial plexus block 0.75% with 10mg of nalbuphine is particularly effective in sensory, motor, and analgesic periods in relation to ropivacaine alone. Keywords: Supraclavicular, Brachial plexus block, Ropivacaine, Nalbuphine, Duration of analagesia

Effect of verapamil as an adjuvant to Levobupivacaine in supraclavicular brachial plexus block

Background: The quest for searching newer and safer anaesthetic agents has always been one of the primary needs in anaesthesiology practice. Levobupivacaine, the pure s (-) enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anaesthesia than its racemic sibling. Also, many adjuvants have been used with local anaesthetics to reduce the time of onset and prolong the duration of analgesia in brachial plexus blocks. However, few studies are there using verapamil as an adjuvant with Levobupivacaine.Aims: The primary aim of the study is to know the effect of verapamil (5mg) as an adjuvant to Levobupivacaine in supraclavicular brachial plexus block.Methods: A Descriptive, Observational study was carried out in 80 ASA Grade I and II patients, undergoing upper limb surgeries under supraclavicular brachial plexus block using ultrasound machine. Local anaesthetic solution was prepared as following. 30ml 0.5% Levobupivacaine + 2ml Verapamil (5mg). The effect of Verapamil as an adjuvant to Levobupivacaine in Supraclavicular Brachial Plexus Block with regards to onset and duration of motor and sensory block, duration of analgesia, need for rescue analgesia and number of rescue analgesia in first 24 hours after surgery was evaluated. Data analysis was done with the help of SPSS Software ver 13.Results: Mean onset time for motor block in our study group was 9.19 ± 1.86minThe mean duration of motor block in our study group was 470.25 ± 42.00 minThe mean onset time for sensory block in our study group was 6.48 ± 2.55 minThe mean duration of sensory block in our study group was 494.88 ± 37.67 minThe mean duration of analgesia in our study group was 517.88 ± 48.24The mean no of reuse analgesia required in the first 24 hours after surgery was 3Conclusion: Verapamil (5 mg) 2 ml can be effectively and safely used as an adjuvant to Levobupivacaine (0.5%) 30ml in Supraclavicular Brachial Plexus Block. However, due to paucity of studies in literature, there is still scope for further study using different calcium channel blocking drugs or in different dosage strengths.

A comparative study of effects of 0.5% isobaric levobupivacaine with 0.5% bupivacaine in interscalene brachial plexus block for upper limb surgeries

Isobaric levobupivacaine is a long acting amide type of local anaesthetic that is S-enantiomer of racemic bupivacaine with clinical profile resembling that of bupivacaine. It has been stated that its faster protein binding rate reflects a decreased degree of toxicity and studies done have supported that it has lesser cardiovascular and central nervous system toxicity than bupivacaine. Sixty patients aged between 18yrs and 60yrs of physical status ASA grade 1 and ASA grade 2 undergoing elective upper limb surgeries were included in the study after ethical clearance from the college ethical committee. The mean duration of motor block in Bupivacaine group was 485.33±59.75 min and 467.67±56.85 min in Levobupivacaine group. There was no significant statistical difference seen between the two groups with regards to duration of motor block (p=0.170).

Efficacy of Intrathecal Neostigmine with Intrathecal Dexmedetomidine in Postoperative Analgesia

Background: The present study was conducted to compare the efficacy of intrathecal neostigmine with intrathecal dexmedetomidine in postop- erative analgesia. Subjects and Methods: The present study was conducted in the department of Anesthesia involving 100 patients belonging to ASA grade I and II, posted for elective Sub umbilical surgeries, under spinal anaesthesia. Group I patients received 3.0ml of hyperbaric solution of 0.5% bupivacaine + 50mcg (0.5ml) of Neostigmine. Group II patients received 3.0ml of hyperbaric solution of 0.5% bupivacaine + 10mcg (0.5ml) of dexmedetomidine. Results: The maximum patients were seen in age group 18-30 years ie 10 in group I and 16 in group II and minimum in 41-50 years ie 6 in group I and 4 in group II. The mean time for onset of sensory block in group I was 1.43 0.53 min and in group II was 2.319 0.44 min. The mean time for onset of peak sensory block in group I was 5.48 0.43 min and Group II was 7.31 0.44 min. Time for two segment regression was significantly higher in dexmedetomidine group as compared to neostigmine group, the mean time for two segment regression in group I was 124.98 21.48 min and group II was 165.24 14.45 min. The mean time for onset of motor block was 3.079 0.44 min in group I and 4.0454 0.38 min in group II. The mean duration of motor block in group I was 191.58 26.81 min and 324 36.8 min in group II. The difference was significant (P&lt; 0.05). The mean sedation score in group I was 1.03 and in group II was 2.07. The difference was significant (P&lt; 0.05). Conclusion: Authors recommend the use of dexmedetomidine as an adjuvant to bupivacaine in subarachnoid block

English

BACKGROUND Blockade of brachial plexus at several locations from the roots to the terminal branches will allow for surgical anaesthesia of the upper extremity and shoulder. We have attempted to compare the efficacy of dexamethasone and dexmedetomidine when used as an adjunct to brachial plexus blockade when used as a sole anaesthetic for upper arm surgeries. METHODS After obtaining ethical committee clearance, a prospective observational study was conducted in patients undergoing upper arm surgeries. Patients were compared in two groups; Group 1 received 18 mL Ropivacaine (0.5 %) and Dexamethasone 8 mg (2 mL); Group 2 received Ropivacaine (0.5 %) and 75 mcg Dexmedetomidine along with 1.25 mL isotonic sodium chloride. RESULTS Mean time of onset of sensory blockade was 12.1 ± 1.1 min in Group 1 and 10.3 ± 1.2 min in Group 2. Mean Duration of Analgesia in Group 1 was 1024.5 ± 62.0 min and in Group 2 was 1394.3 ± 189.6 min. Mean Onset of Motor block in Group 1 was 18.2 ± 1.5 min and in Group 2 was 14.7 ± 1.0 min. Mean Duration of motor block in Group 1 was 697.2 ± 37.3 min and in Group 2 was 776.3 ± 48.0 min. CONCLUSIONS Our study revealed that dexmedetomidine is a better alternative for decreasing the onset of motor block along with enhanced quality and duration of supraclavicular block. KEYWORDS Interscalene, Dexamethasone, Dexmedetomidine

Comparative evaluation of levobupivacaine-fentanyl and ropivacaine - fentanyl in epidural anaesthesia in lower limb orthopaedic surgeries in elderly patients

Epidural blockade with levobupivacaine and ropivacaine, the two new long-acting local anaesthetics, have been preferred in elderly due to low cardiac and central nervous system toxicity.A randomized prospective study was conducted on 100 patients having age 60-85 yr of ASA physical status I, II and III admitted for elective lower limb orthopaedic surgeries under epidural anesthesia. Patients were randomly divided into two groups, Group A received epidural levobupivacaine 0.5% (13ml) and Group B received ropivacaine 0.75% (13ml), both with fentanyl 100 µg (2ml). Time of onset, peak level and time to attain peak level of the sensory block &amp; time of regression upto two segment along with duration of analgesia were noted. Onset time and duration of motor block, hemodynamics and adverse effects were also compared in the two groups. Onset time of sensory block in group A was 5.74±0.66 minutes, while it was 5.68±0.62 minutes in group B.Maximum sensory block was attained in 8.58 ± 0.81 minutes in group A and 8.52 ± 0.84 minutes in group B. 134.2±8.10 minutes were taken for two segment regression in group A, while the time taken in group B was 134±10.88 minutes. Motor blockade mean onset time was 20±3.35 minutes and 20.2±3.64 minutes in group A and group B respectively. The mean duration of motor block in group A was 248.4±13.60 minutes and 247.8±13.29 minutes in group B. The mean duration of analgesia was 382±18.63 minutes in group A, while it was 382.4±15.98 minutes in group B. Results were comparable with regards to sensory and motor blockade parameters, hemodynamics and adverse effects. Both 0.5% levobupivacaine and 0.75% ropivacaine with fentanyl as adjuvant are effective and comparable for epidural anaesthesia in elderly patients with regard to sensory and motor block characteristics along with similar hemodynamic profile.